Parenteral metoclopramide for acute migraine: meta-analysis of randomised controlled trials

doi:10.1136/bmj.38281.595718.7C

BMJ, doi: 10.1136/bmj.38281.595718.7C, (Published 18 November 2004)

PAPERS

Parenteral metoclopramide for acute migraine: meta-analysis of randomised controlled trials

Ian Colman ¹, Michael D Brown ², Grant D Innes ³, Eric Grafstein ³, Ted E Roberts ⁴, Brian H Rowe ⁵

¹ Department of Psychiatry, University of Cambridge, Cambridge CB2 2QQ
² Program in Emergency Medicine, Michigan State University, MI, 49503, USA
³ Department of Emergency Medicine, Providence Health Care and St Paul's Hospital, Vancouver, BC, Canada
⁴ Department of Medicine, University of Alberta, Edmonton, AB, Canada
⁵ Division of Emergency Medicine, University of Alberta, 1G1.43 Walter Mackenzie Health Sciences Center, 8440-112 Street, Edmonton, AB, Canada T6G 2B7

Objective To assess the evidence from controlled trials on theefficacy and tolerability of parenteral metoclopramide for acutemigraine in adults.

Data sources Cochrane Central Register ofControlled Trials, Medline, Embase, LILACS, CINAHL, conferenceproceedings, clinical practice guidelines, and other sources.

Selectioncriteria Randomised controlled trials of parenteral metoclopramidefor acute migraine in adults.

Results We reviewed 596 potentiallyrelevant abstracts and found 13 eligible trials totalling 655adults. In studies comparing metoclopramide with placebo, metoclopramidewas more likely to provide significant reduction in migrainepain (odds ratio 2.84, 95% confidence interval 1.05 to 7.68).Used as the only agent, metoclopramide showed mixed effectivenesswhen compared with other single agents. Heterogeneity of studiesfor combination treatment prevented statistical pooling. Treatmentsthat did include metoclopramide were as, or more, effectivethan comparison treatments for pain, nausea, and relapse outcomesreported in all studies.

Conclusions Metoclopramide is an effectivetreatment for migraine headache and may be effective when combinedwith other treatments. Given its non-narcotic and antiemeticproperties, metoclopramide should be considered a primary agentin the treatment of acute migraines in emergency departments.

(Accepted 6 October 2004)

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

StumbleUpon Add to Technorati

Technorati What's this?

Relevant Articles

Treat migraine with parenteral metoclopramide
BMJ 2004 329: 0. [Full Text] [PDF]

Public health's Holy Grail: Kamran Abbasi
BMJ 2004 329: 0. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Charbit, A. R, Akerman, S., Goadsby, P. J (2009). Comparison of the Effects of Central and Peripheral Dopamine Receptor Activation on Evoked Firing in the Trigeminocervical Complex. J. Pharmacol. Exp. Ther. 331: 752-763 [Abstract] [Full text]
Friedman, B. W., Greenwald, P., Bania, T. C., Esses, D., Hochberg, M., Solorzano, C., Corbo, J., Chu, J., Chew, E., Cheung, P., Fearon, S., Paternoster, J., Baccellieri, A., Clark, S., Bijur, P. E., Lipton, R. B., Gallagher, E. J. (2007). Randomized trial of IV dexamethasone for acute migraine in the emergency department. Neurology 69: 2038-2044 [Abstract] [Full text]
Parlak, I., Erdur, B., Parlak, M., Ergin, A., Turkcuer, I., Tomruk, O., Ayrik, C., Ergin, N. (2007). Intravenous administration of metoclopramide by 2 min bolus vs 15 min infusion: does it affect the improvement of headache while reducing the side effects?. Postgrad. Med. J. 83: 664-668 [Abstract] [Full text]
Brenner, S. R., Allena, M., Magis, D., Schoenen, J., Friedman, B.W., Corbo, J., Lipton, R.B., Bijur, P.E., Esses, D., Gallagher, E.J. (2005). A trial of metoclopramide vs sumatriptan for the emergency department treatment of migraines. Neurology 65: 1339-1340 [Full text]
Loder, E. W (2005). Review: intravenous metoclopramide is better than placebo for reducing pain in acute migraine in the emergency department. Evid. Based Med. 10: 83-83 [Full text]
Fox, A. W., Kori, S. H. (2005). Pharmacokinetic opportunities for combination therapy in migraine. Neurology 64: S21-S25 [Full text]
(2005). Parenteral Metoclopramide for Acute Migraine. Journal Watch Dermatology 2005: 10-10 [Full text]
(2005). Metoclopramide: Another Good Choice for Migraine. JWatch Emergency Med. 2005: 2-2 [Full text]
(2005). Parenteral Metoclopramide for Acute Migraine. JWatch General 2005: 5-5 [Full text]

Rapid Responses:

Read all Rapid Responses

Tips for migraine sufferers (with visual aura): Adrian S. Blaj
bmj.com, 20 Nov 2004 [Full text]
Meta-analysis of role of metoclopramide for aborting migraine attacks: quo vadis?: Vinod K Gupta
bmj.com, 26 Nov 2004 [Full text]
Number not to respond ?: Axel Ellrodt
bmj.com, 10 Dec 2004 [Full text]
Beware parenteral metoclopramide: Barry G Smiler
bmj.com, 13 Dec 2004 [Full text]
Metoclopramide not "the drug of first choice": Peter J Effeney
bmj.com, 14 Dec 2004 [Full text]
Is there a possibility of bias?: Ramesh Donepudi
bmj.com, 14 Dec 2004 [Full text]
Need to carry out detailed work on Metoclopramide: Dr Buddhi P Paudyal
bmj.com, 15 Dec 2004 [Full text]
First-line use of intravenous metoclopramide for migraine: an unsubstantiated proposition: Shilpa Patel
bmj.com, 10 Jan 2005 [Full text]
At last!: Diane-Marie Campbell
bmj.com, 12 Jan 2005 [Full text]